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C-section rates increase across Minnesota

More than one-quarter of births to first-time moms in Minnesota are by cesarean section, according to a report released on Tuesday.

That's a troubling statistic, a health economist with the state's Department of Health said.

"There is a fair amount of evidence that the increased interventions have not really had a bearing on the health of the mothers or their babies," said Stefan Gildemeister, program director for health economics. "So we should ask: Why are we doing it?"

The Department of Health funded the look at C-sections in the MN Community Measurement's annual Health Care Quality Report because of the overall increase in the rate of C-sections, Gildemeister said.

The overall rate in Minnesota rose from 16.6 percent in 1992 to 27.6 percent in 2012, he said. That's lower than the national rate of 33 percent reported in 2011 by the Centers for Disease Control and Prevention.

The health department wanted the measure of C-sections for first-time pregnancies included in the ninth annual quality report because it allows consumers to compare rates from one clinic to another and ask questions, Gildemeister said.

"I think for consumers there's a really important message in this, giving them the tools to ask their providers: Why would I have a higher likelihood of having a C-section if I come to you than to other places?" he said.

The rates vary widely across the state, according to the report, from as low as 14 percent to as high as 51 percent of all first-time pregnancies ending in delivery by C-section.

Among five clinics rated in Northeastern Minnesota, the rate ranged from 19.3 percent at Grand Itasca Clinic in Grand Rapids to 32.1 percent at Virginia Regional Medical Center Clinical Services, which now is part of the Essentia Health system. In Duluth, Essentia Health-Duluth Clinic was at 30.4 percent.

But comparison shopping is exactly the wrong focus, a Duluth obstetrician said.

"If you pick an arbitrary, random, non-evidence-based ideal number ... and if you're below that you're labeled as good and above that you're labeled as bad, it's divisive, it's random; it really doesn't help solve the problem," said Dr. Patricia O'Day, Essentia Health maternal fetal medicine specialist.

Various factors can affect the percentage of pregnancies that end with cesarean deliveries, O'Day said. Essentia Health in Duluth gets a large number of high-risk pregnancies because of its neonatal intensive care unit. That means pregnancies that are more likely to require a C-section.

The percentage of C-sections also has been rising for various reasons, she said. Fetal monitoring has improved, meaning potential problems that make a C-section advisable are more likely to be spotted. The well-documented increase in obesity and diabetes results in more problem pregnancies than in the past.

But C-sections should be avoided whenever possible, O'Day said. Although it is a low-risk surgery, "no one should have abdominal surgery or any surgery unless it's necessary," she said.

C-sections present risks of complication that aren't present with vaginal births, Gildemeister said. And C-sections cost about twice as much.

But instead of comparing numbers, people should look at ways to avoid complicated pregnancies, O'Day said.

"It's really: What can you do to lower your chance of having a complicated pregnancy, including a cesarean delivery?" O'Day said. "And it's all of those things that we know that's good for us that none of us like to do, like diet and exercise and living a good life."